| NPI | 1225175524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NV 16690) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 23730) |
| 207X00000X Orthopaedic Surgery (Licence: NY 254960-1) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-03-07 |